Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea.
Thorac Cancer. 2023 Feb;14(6):624-635. doi: 10.1111/1759-7714.14796. Epub 2023 Jan 11.
The role of adjuvant chemotherapy in esophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to evaluate the impact of adjuvant chemotherapy on survival in patients with positive nodes after surgery for ESCC.
We retrospectively reviewed the survival outcomes of node-positive patients with ESCC who underwent curative resection with or without adjuvant chemotherapy between January 1994 and December 2015.
We analyzed 460 patients (333 adjuvant chemotherapy, 127 surgery alone). The surgery-alone group was older (64 vs. 60 years, p < 0.001) and had more comorbidities (p = 0.004) than the adjuvant chemotherapy group. After propensity score matching, overall survival (OS) and recurrence-free survival (RFS) of the adjuvant chemotherapy group were better than those of the surgery-alone group: 5-year OS rate 62.7% (95% confidence interval [CI] 54.4-72.3%) vs. 46.8% (95% CI 38.5-57%, p = 0.001) and 5-year RFS rate 53.9% (95% CI 45.4-63.9%) vs. 36.2% (95% CI 28.3-46.3%, p < 0.001). Notably, in patients with pT3-4 stage, the adjuvant chemotherapy group had significantly better 5-year OS rate (41.3% [95% CI 29.3-58.3%] vs. 18% [95% CI 10-32.5%], p = 0.01) and 5-year RFS rate (37% [95% CI 25.3-53.9%] vs. 12% [95% CI 5.7-25.4%], p < 0.001) than in the surgery-alone group. In multivariable analysis, adjuvant chemotherapy had a favorable effect on both OS (hazard ratio [HR] 0.562, 95% CI 0.426-0.741, p < 0.001) and RFS (HR 0.702, 95% CI 0.514-0.959; p = 0.026).
Adjuvant chemotherapy may improve survival in node-positive patients with ESCC, especially in those with pT3-4 stage.
辅助化疗在食管鳞癌（ESCC）中的作用仍存在争议。本研究旨在评估辅助化疗对 ESCC 术后阳性淋巴结患者生存的影响。
我们回顾性分析了 1994 年 1 月至 2015 年 12 月期间接受根治性切除术且有或无辅助化疗的阳性淋巴结 ESCC 患者的生存结局。
我们分析了 460 例患者（333 例接受辅助化疗，127 例仅手术治疗）。手术组年龄较大（64 岁 vs. 60 岁，p<0.001），合并症更多（p=0.004）。经倾向评分匹配后，辅助化疗组的总生存（OS）和无复发生存（RFS）均优于手术组：5 年 OS 率为 62.7%（95%CI 54.4-72.3%）vs. 46.8%（95%CI 38.5-57%，p=0.001）和 5 年 RFS 率为 53.9%（95%CI 45.4-63.9%）vs. 36.2%（95%CI 28.3-46.3%，p<0.001）。值得注意的是，在 pT3-4 期患者中，辅助化疗组的 5 年 OS 率（41.3%[95%CI 29.3-58.3%] vs. 18%[95%CI 10-32.5%]，p=0.01）和 5 年 RFS 率（37%[95%CI 25.3-53.9%] vs. 12%[95%CI 5.7-25.4%]，p<0.001）明显优于手术组。多变量分析显示，辅助化疗对 OS（风险比[HR]0.562，95%CI 0.426-0.741，p<0.001）和 RFS（HR 0.702，95%CI 0.514-0.959；p=0.026）均有获益。
辅助化疗可能改善 ESCC 阳性淋巴结患者的生存，尤其是 pT3-4 期患者。
